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Impact of Centralized Management of Bariatric Surgery Complications on 90-day Mortality

Caiazzo, Robert, MD, PhD*,†; Baud, Gregory, MD, PhD*,†; Clément, Guillaume, MD; Lenne, Xavier, MD; Torres, Fanelly, MD*,†; Dezfoulian, Guelareh, MD§; Lebuffe, Gilles, MD, PhD; Kipnis, Eric, MD, PhD; Dervaux, Benoit, MD, PhD; Pattou, Francois, MD*,†

doi: 10.1097/SLA.0000000000002949
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Background and Aims: The potential benefit of the centralization of Bariatric surgery (BS) remains debated. The aim of this study was to evaluate the impact on 90-day mortality of an innovative organization aiming at centralizing the care of severe postoperative complications of BS.

Study Design: The centralization of care for postoperative complication after BS was implemented by French Authorities in 2013 in the Nord-Pas-de-Calais Region, France. This unique formalized network (OSEAN), coordinated by 1 tertiary referral center, enrolled all regional institutions performing bariatric surgery. Data were extracted from the medico-administrative database providing information on all patients undergoing BS between 2009 and 2016 in OSEAN (n = 22,928) and in Rest of France (n = 288,942). The primary outcome was the evolution of 90-day mortality before and after the implementation of this policy. Rest of France was used as a control group to adjust the results to improvement with time of BS outcomes.

Results: The numbers of primary procedure and reoperations increased similarly before and after 2013 within OSEAN and in Rest of France. The 90-day mortality rate became significantly lower within OSEAN than in the rest of France after 2013 (0.03% vs 0.08%, P < 0.01). This difference was confirmed in multivariate analysis after adjustment to the procedure specific mortality (P < 0.04). The reduction of 90-day mortality was most visible for sleeve gastrectomy.

Conclusion: The implementation of centralized care for early postoperative complications after BS in OSEAN was associated with reduced 90-day mortality. Our results indicate that this reduction was not due to a lower incidence of complications but to the improvement of their management.

*General and Endocrine Surgery, CHU Lille, Lille, France

Inserm, U1190 Translation Research in Diabetes, Univ Lille, Lille, France

Medical Information Department, CHU Lille, Lille, France

§General and Digestive Surgery, Valenciennes, France

Anesthesiology and Intensive Care Department, CHU Lille, Lille, France.

Reprints: Francois Pattou, MD, General and Endocrine Surgery, Hopital Huriez, Lille University Hospital, Rue M Polonovski, 59000 Lille, France. E-mail: francois.pattou@univ-lille.fr.

On behalf of the OSEAN study group (see appendix; http://links.lww.com/SLA/B497 for a complete list of members).

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

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